| ObjectivesTo explore the role of serum FGF23, MGP and Fetuin-A in the calcium-phosphate metabolism and cardiovascular disease in maintenance hemodialysis patients. And further to explore the predictive value of serum FGF23, MGP and Fetuin-A in cardiovascular disease, coronary artery calcification and osteoporosis in maintenance hemodialysis patients.Methods64cases of maintenance hemodialysis patients recruited into our study were diagnosed with end-stage renal disease in our hospital between February2011and February2012. Basic clinical information, including gender, age, dialysis age, body mass index and primary disease were collected in our study. All the patients’blood samples were collected to determine hemoglobin, Ferritin, intact parathyroid hormone, serum albumin, urea nitrogen, creatinine, total cholesterol, triglycerides, high density lipoprotein, low density lipoprotein, calcium, phosphate and alkaline phosphatase levels. Serum albumin was used to calculate corrected serum calcium levels and then calcium-phosphorus product. At the same time, the serum of all the patients were preserved and then the serum FGF23, MGP and Fetuin-A were quantified by enzyme-linked immunosorbent assay (EL1SA). Coronary artery calcification score was obtained by CT scan of coronary artery; Intima-media thickness of carotid artery was determined with color Doppler B ultrasonic instrument; Bone mineral density at the femoral neck was measured by dual-energy X-ray absorptiometry.Results1.64patients, including30males and34females were enrolled. Mean age was60.6±11.3years, and the mean dialysis age was6.88±2.94years. According to the occurrence of cardiovascular disease, the patients were divided into cardiovascular disease group, non-cardiovascular disease group. Among them,27cases (42.19%) had cardiovascular disease and37cases (57.81%) not. In cardiovascular disease group, the age, CACS, IMT, BMI, dialysis age, serum FGF-23, MGP, P, Ca×P product and iPTH were significantly higher than non-cardiovascular disease group, while serum Fetuin-A and HDL were significantly lower than non-cardiovascular disease group. CACS, dialysis age, IMT, serum FGF-23, Fetuin-A, P and iPTH were found to be independent variables that influenced the occurrence of cardiovascular disease by logistic regression analysis. The ROC curves analysis conformed that serum FGF-23and Fetuin-A were useful for identifying cardiovascular disease in MHD patients. The cutoff value with the highest Youden’s index was defined as the optimal predictors of cardiovascular disease:serum FGF-23>224pg/ml and Fetuin-A<95ug/ml, then their sensitivity/specificity was70%/79.2%,94.4%/40.9%, respectively. Different combination of serum FGF-23and Fetuin-A in parallel or in series boosted identification of cardiovascular disease.2. According to the coronary artery calcification score, the patients were divided into positive group and negative group of coronary calcification;35cases (54.69%) were in positive coronary artery calcification group and29cases (45.31%) were in negative group. In positive group, CACS, IMT, BMI, dialysis age, serum FGF-23, MGP, P and Ca×P was significantly higher than the negative group, while Kt/V, serum Fetuin-A and HDL were significantly lower than the negative group. Dialysis age, serum FGF-23, Fetuin-A, P and HDL were found to be independent variables that influenced the coronary artery calcification score by stepwise multiple regression analysis. The ROC curves analysis conformed that serum FGF-23and Fetuin-A were useful for identifying coronary artery calcification in MHD patients. The cutoff value with the highest Youden’s index was defined as the optimal predictors of coronary artery calcification:serum FGF-23≥256pg/ml and Fetuin-A<85ug/ml, then their sensitivity/specificity was63.68%/81.8%,68.4%/71.4%, respectively. Different combination of serum FGF-23and Fetuin-A in parallel or in series boosted identification of coronary artery calcification.3. According to the femoral neck bone mineral density, the patients were divided into normal group, osteopenia group and osteoporosis group;10,24, and30cases were in normal, osteopenia, osteoporosis group, respectively. BMI, Kt/V, dialysis age, age, serum FGF-23, Fetuin-A and calcium were statistically significant different among the three groups. BMI, Kt/V, dialysis age and serum Fetuin-A were found to be independent variables that influenced the bone mineral density of femoral neck by stepwise multiple regression analysis. The ROC curves analysis conformed that serum Fetuin-A was useful for identifying osteoporosis in MHD patients. The cutoff value with the highest Youden’s index was defined as the optimal predictor of osteoporosis:serum Fetuin-A<89ug/ml, then its sensitivity/specificity was71%/77.8%.Conclusions1. Serum phosphate, iPTH, FGF-23and Fetuin-A can influence the occurrence of cardiovascular disease in MHD patients. Actively control the level of serum phosphate, calcium-phosphate product and iPTH can reduce the occurrence of cardiovascular disease in MHD patients. CACS and IMT of carotid artery can predict the occurrence of cardiovascular disease in MHD patients. Excessive serum FGF-23levels and low serum Fetuin-A were predictive biomarkers for the occurrence of cardiovascular disease in MHD patients.2. In MHD patients, there was a higher incidence of coronary artery calcification. Serum FGF-23and fetuin-A concentration were closely correlated with coronary artery calcification and they can be markers for predicting coronary artery calcification.3. In MHD patients, there was a higher incidence of osteoporosis. Serum fetuin-A concentration was closely correlated with osteoporosis and it may serve as markers for osteoporosis. |
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